title: Color vision deficits during laser lithotripsy using safety goggles for coumarin green or alexandrite but not with holmium:YAG laser safety goggles.
abstract: OBJECTIVE
  Laser lithotripsy requires urologists to wear laser eye protection. Laser eye protection devices screen out specific light wavelengths and may distort color perception. This study tests whether urologists risk color confusion when wearing laser eye protection devices for laser lithotripsy.
  
  
  METHODS
  Urologists were tested with the Farnsworth Dichotomous Test for Color Blindness (D-15) and the Farnsworth-Munsell 100-Hue Test (FM-100) without (control) and with laser eye protection devices for coumarin green, alexandrite and holmium:YAG lasers. Error scores were tabulated. The pattern of color deficits was characterized with confusion angles, confusion index (C-index), scatter index (S-index) and color axes. Laser eye protection devices were tested with spectrophotometry for spectral transmittance and optical density.
  
  
  RESULTS
  The D-15 transposition errors (mean plus or minus standard deviation) for control, holmium:YAG, alexandrite and coumarin green laser eye protection were 0 +/- 0, 0 +/- 0, 0.3 +/- 0.5 and 6.4 +/- 1.6, respectively (p = 0.0000001). The FM-100 error scores (mean plus or minus standard deviation) were 20 +/- 15, 20 +/- 14, 91 +/- 32 and 319 +/- 69, respectively (p = 0.0001). The confusion index scores indicated a mild color confusion for the alexandrite and pronounced color confusion for the coumarin green laser eye protection. The confusion angles and scatter indexes mimicked a congenital blue-yellow deficit for coumarin green laser eye protection. Color axes showed no significant deficits for control or holmium:YAG laser eye protection in any subject, red-green axis deficits in 3 of 6 tested with alexandrite and blue-yellow axis deficits in 12 of 12 tested with coumarin green (p < 0.001). Spectrophotometry showed that laser eye protection for coumarin green blocks light less than 550 nm., alexandrite blocks light greater than 650 nm. and holmium:YAG blocks light greater than 825 nm.
  
  
  CONCLUSIONS
  Laser eye protection for coumarin green causes pronounced blue-yellow color confusion, whereas alexandrite causes mild red-green color confusion among urologists, holmium:YAG causes no significant color confusion compared to controls. The differences are explained by laser eye protection spectrophotometry characteristics and visual physiology.
authors.affiliation: Division of Urology, University of Texas Health Science Center, San Antonio, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Teichman
authors.forename: A J
authors.initials: AJ
authors.lastname: Johnson
authors.forename: J T
authors.initials: JT
authors.lastname: Yates
authors.forename: B N
authors.initials: BN
authors.lastname: Angle
authors.forename: M S
authors.initials: MS
authors.lastname: Dirks
authors.forename: J T
authors.initials: JT
authors.lastname: Muirhead
authors.forename: I M
authors.initials: IM
authors.lastname: Thompson
authors.forename: M S
authors.initials: MS
authors.lastname: Pearle
mesh_terms: D000328:Adult; D000535:Aluminum; D003117:Color Vision Defects / Q000209:etiology*; D003374:Coumarins; D005135:Eye Protective Devices; D006695:Holmium; D006801:Humans; D007834:Lasers; D017602:Lithotripsy, Laser / Q000295:instrumentation*; D015019:Yttrium
chemical_list: D003374:Coumarins; D015019:Yttrium; D000535:Aluminum; D006695:Holmium